Health care is a major concern for most people in the United States, given the anxiety that comes with treating life-threatening acute or debilitating chronic conditions while accessing care or paying for medical services. Despite the country’s $4 trillion spending in 2021, life expectancy continues to languish compared to other developed countries, with the US having the highest per capita spending in the world. Therefore, it is crucial to discuss and resolve the issues surrounding health care in the US.
For many people, health insurance is tied to their employment, creating a patchwork of coverage that is prone to cracking during transitions. COBRA may provide insurance at its own expense if there is a gap in employment. The Affordable Care Act ensures that everyone has access to health insurance without restrictions on pre-existing medical conditions. Moreover, the growth of the gig economy highlights the need to decouple health care from traditional employment.
One solution is to separate the provision of medical services from the payment for these services. Such segregation is critical to address the lack of access to health services and highlight problems in the health care system. For most people, medical services are covered by health insurance, and health insurance companies are highly profitable. The question is whether commodities that provide public goods, such as health care services, should be in a position to generate profit from such public needs.
One alternative is a single payer system, much like Medicaid, Medicare, and Veterans Affairs. This topic is a controversial lightning rod. Still, a single payer system does not mean that the government provides the service, but it is just a funnel for medical services to be paid for. Single payer systems exist in 17 countries and provide a model of how to implement it in the United States. A second option is to establish and grow a network of non-profit health insurers. As health care providers accept insurance exclusively from these groups, for-profit corporations will eventually be phased out.
The disconnect between health plans, providers, and patients creates an equilibrium that is in the best interests of health insurers while at the mercy of patients and providers of these companies. As intermediaries, health insurance companies effectively control the flow of medical services to patients through prior approval. This means that health care providers are effectively working for health insurance companies to pay for the services they provide. For providers and patients, there is a glimmer of hope.
Health insurance companies’ recent changes to the pre-authorization process implicitly recognize this issue and represent a move in the right direction. The center of medical care must be the patient, and doctors and other medical professionals must steer the ship. In the current environment, health insurance companies are to blame. This hurts because patients may not receive the care they need and deserve. This hurts because doctors and other health care professionals are forced to expend time and resources to fight for their patients and be paid for their services.
To resolve the issues surrounding health care in the United States, it is crucial to separate the services provided from the finances that pay for them. The financial component overwhelms the service component, and the current situation will continue to the detriment of doctors, health professionals, and patients until this issue is resolved.